1. Intravenous Therapy IV Infusion Preparations Fluid and Electrolytes
Sasha A. Rarang, RN, MSN

2. Intravenous (IV)Therapy :
Definition: Infusion of a fluid into a vein
to prevent or treat fluid &/or electrolyte imbalance(s)
to deliver medications
to deliver blood products
VENIPUNCTURE: technique of accessing a vein via insertion of a needle or catheter
sterile procedure because skin integrity is broken

3. Purposes of Infusion Therapy:
Provide fluids when PO intake not possible
replace fluids/lytes
Maintain normal electrolyte balances
Provide glucose as energy source
Provide access for administration of meds
Administer blood products
Emergency access
Maintain urine output

4. Distribution of Body Fluids & Electrolytes:
Typical adult % body weight consists of fluid (water & lytes)
varies with body fat content, age, sex
ex. fat cells contain little water; lean tissue is rich with water
ex. infants have a high body fluid content (approx % of body weight)

5. Fluid Distribution: INTRACELLULAR (ICF) EXTRACELLULAR (ECF)
within the cells
approx 2/3 of total fluid found within ICF
EXTRACELLULAR (ECF)
outside the cells
approx 1/3 of total fluid found within ECF
ECF: 2 compartments
Intravascular Within a vessel; Plasma
Interstitial/Extravascular Between & around the cells; Tissue Fluid

6. Electrolytes:
A substance that develops an electrical charge when dissolved in water
Electrolyte content of ICF is different from ECF
Major electrolytes in ICF: Potassium; Phosphate; Magnesium
Major electrolytes in ECF: Sodium; Chloride; Bicarbonate; Calcium

7. Movement of Fluids: Normal mvmt of fluids through capillary walls depends on 2 forces
Hydrostatic Pressure - pressure exerted by the heart; pressure of blood volume in vessels
Oncotic Pressure - pressure exerted by plasma proteins such as albumin
Water is pulled toward higher oncotic pressure

8. Movement of Fluids:
When solutions are separated by a membrane impermeable to dissolved substances, a shift of water occurs through the membrane from an area of low solute concentration to higher solute concentration
Magnitude of this force dependent on the number of particles dissolved
OSMOLALITY: number of dissolved particles
TONICITY; OSMOLARITY
amt of solutes (ex sugar, Na+, protein) in a liter of solution

9. Intravenous Infusion Preparations
Osmolality – osmotic pull or pressure exerted by all particles by unit of water
( expressed in milliosmoles per kilogram)
Osmolarity- is the osmotic pull by all particles per unit of solution. Unit of osmotic pressure – osmole ( Osm) and the milliosmole is mOsm is 1/1000th of an osmole. Osmotic cpressure determines osmotic activity.
Osmotic pressure determines osmotic activity.

10. Osmolality
Influience by the quantity of dissolved particles that exerts an osmotic pull in the intracellular and extracelluar fluids.
Primary solutes – serum sodium, urea, and glucose.
Plasma (intravascular compartment ) contains protein and slightly higher osmolality than fluid in other areas.
25% concentration only that found in the ICF.
Interstitial fluid has little to no protein.
It is the responsibuility of the nurse to knowwherther a prescribed infusate is hypertonic, hypotonic, or isotonic.

11. Osmolality: The more solute present; the higher the osmolality
ISOTONIC solutions have the same osmolality as body fluids
HYPOTONIC solutions have a lower osmolality as body fluids
HYPERTONIC solutions have a higher osmolality as body fluids

12. Isotonic Solutions: same osmotic pressure as that found in the cell
Will not alter intracellular fluid compartments
ex. Normal Saline (NS): used to expand ECF compartments
ex. Lactate Ringers (LR): similar to plasma content (Na, K, Ca, Cl, Lactate); used to correct ECF deficits

13. Hypotonic Solutions: less osmotic pressure as that found in the cell
have lower osmolality than body fluids within the cell (ICF)
cause fluids to shift out of the vasculature (ECF) & into the cells (ICF)
used to provide water, cellular hydration
ex. 0.45% NS (“half Normal Saline”)
ex. D5W (“5% dextrose water”)

14. Hypertonic Solutions: greater osmotic pressure as that found in the cell
HIGHER osmolality than body fluids
causes fluids to shift out of the cells (ICF) into the vascular space
rapid shift fr ICF into the ECF/ vascular beds
given to treat specific problems
can potentially have serious side effects
ex. CHF, PE, overload
ex. Hypertonic saline (3% or 5% NS)
ex. TPN
ex. 50% dextrose

15. Classification of Infusates
Crystalloid
Colloids
Hydrating Solution
Electrolyte Solution
Dextrose Solution

16. Crystalloids Materials that are capable of crystallization.
Solution that when place on solvent , homogeneously mixed with and dissolved into a solution and cannot be distinguished from the resultant solution.
Can be isotonic, hypertonic, or hypotonic.

17. Hydrating Solution Provide free water for maintenance or hydration.
When used chemical make-up or rate of administration is adjuted so the equilibria of fluids are not disturbed.
E.g. glucose solution are most often used.
Dextrose 21/2 % in 0.45 % saline
Dextrose 5% in water
Dextrose 5% in 0.45 saline
Sodium Chloride 0.45%
Dextrose 5% in 0.2% saline.

18. Electrolyte Solution
Substance capable of ionization such as sodium chloride

19. Dextrose solutions
Are frequently used as infusates, are manufactured as percentage solutions expressed the numberof grams per 100 g of solvent,.
A 5% dextrose in water (D5W) infusions contains 5 g of dextrose in 100 ml of water 1 ml of water equals 1 gr.

20. Colloids
Are glutinous substances whose particles, when submerge into a solvent, cannot form a true solution because their molecules when thoroughly dispersed no not dissolve, but remained uniformly suspended and distributed throughout the fluid.
Can raise osmotic pressure.
Plasma or volume expander.
E.g. dextran, plamanate, and artificial blood substitute, hetastarch.

21. Indications for IV Therapy
Fluid Volume maintenance
Fluid Volume replacement
Medication Administration
Blood and Blood Producct Donation and administration
Nutritional support.

22. Equipment and Supplies
Infusate container – glass
Plastic – flexible
Semiregid
Infusate administration container
Drop factor
Primary administration set
Secondary administration set
Volume control administration set
Blood and Blood product administration set
Accessory Devices for use with administration set
Needleless Systems and Needlestick Safety System